Comparison of the efficacy of electroconvulsive therapy (ECT) plus agomelatine to ECT plus placebo in treatment‐resistant depression

• Published in: Acta psychiatrica Scandinavica Vol. 142; no. 2; pp. 121 - 131
• Main Authors: Lin, C.‐H., Yang, W.‐C., Chen, C.‐C., Cai, W.‐R.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01-08-2020
• Subjects: 17‐item Hamilton Depression Rating Scale; Acetamides - administration & dosage; Acetamides - therapeutic use; Adult; Aged; agomelatine; Combined Modality Therapy; Depressive Disorder, Treatment-Resistant - drug therapy; Depressive Disorder, Treatment-Resistant - therapy; Electroconvulsive Therapy; Female; Humans; major depressive disorder; Male; Mental depression; Middle Aged; Patients; Psychiatric Status Rating Scales; Quality of Life; Remission; Statistical analysis; Treatment Outcome; treatment‐resistant depression; Young Adult; treatment-resistant depression; 17-item Hamilton Depression Rating Scale; electroconvulsive therapy; major depressive disorder; agomelatine
• ISSN: 0001-690X; 1600-0447
• DOI: 10.1111/acps.13183

Objective
Electroconvulsive therapy (ECT) is commonly used to treat patients with treatment‐resistant depression. We aimed to investigate whether combining an antidepressant agent with ECT might enhance therapeutic efficacy and prevent early relapse.
Method
During the acute ECT phase, patients (N = 97) with treatment‐resistant depression were randomized to receive ECT plus agomelatine 50 mg/day (n = 48) or ECT plus placebo (n = 49). Symptom severity measures, including the 17‐item Hamilton Depression Rating Scale (HAMD‐17) and other scales, functional impairment, quality of life, neuropsychological tests, adverse events and attitudes toward ECT, were assessed regularly. Remission was defined as a HAMD‐17 score ≤7. If patients achieved post‐ECT remission, they were prescribed agomelatine 50 mg/day and participated in a 12‐week follow‐up trial. HAMD‐17 was rated at 4‐week intervals. Relapse was defined as a HAMD‐17 score ≥14, or rehospitalization for a psychiatric reason.
Results
The two treatment groups were comparable at (i) baseline variables; (ii) score changes in all symptom measures, functional impairment, quality of life, and neuropsychological tests; (iii) frequency of adverse events and attitudes toward ECT; and (iv) post‐ECT response/remission rates. There were no statistically significant differences following ECT in relapse rates and time to relapse between these two groups.
Conclusion
Adding agomelatine to ECT yielded comparable response/remission rates to ECT without agomelatine in the acute ECT phase. Starting agomelatine in combination with ECT did not seem to be more efficacious in preventing relapse than starting agomelatine after the acute ECT course. More research is needed to guide clinical recommendations.